The effects of terminal illness on patients and their carers.

As part of a larger study, this paper describes the development and design of a project looking at the experiences of the relatives and carers of terminally ill patients in one health authority, as a replication of a similar study undertaken in another area. Following a description of the problems associated with studies into the problems of dying people and of the method used here, the results indicate that there are quite important effects on the household and carers, which include the problem of obtaining a diagnosis of terminal illness, and the actual process of dying. The study also highlights some of the effects of the terminal illness on the patients and their carers. In particular the results indicate that it was usually a spouse or the daughter who bore the brunt of the care, but that most preferred to retain their independence of the services as long as possible. Often, carers (and the patients) were not fully appraised that a terminal stage had been reached. Some doctors seemed reluctant (or found it difficult) to admit that such a stage had been reached. For many, the experience of dying was a very slow, distressing and often painful period, with serious limitations on their lifestyle imposed by the illness. A number of these limitations could have been reduced if earlier diagnosis had been made or if community nursing or social services had been called in sooner.

Evaluation of nursing process documentation.

Following the introduction of a nursing process and associated documentation in one hospital, an attempt was made to evaluate the effectiveness of the documentation as a record of the nursing process. Two questionnaires were developed, based on previous research in this field, one for the assessment of the documentation, and the other to assess the attitudes and practices of the ward sisters regarding its implementation. The findings indicated that, generally, the assessment phase of the process was poorly documented and that many psychological and social problems were not addressed as well as others. The interventions were relevant but contained little detail. The evaluation section was fair but updating and re-assessment where relevant were poor. Some sisters seemed to display a lack of understanding of the principles or the practice of the process, despite in-service education. Lessons to be learnt from the exercise are suggested.